Mission Trip 2024 - Boston

Personal Information:

Name

This address will receive a confirmation email

Phone

Please share with us why would you like to be a part of this Mission Trip.

I agree to attend the required training meetings prior to the trip, held on May 5, June 2, and July 7, from 6:30 – 8:00 pm at WPC.

Please list any allergies or dietary restrictions:

Is there anything else you would like us to be aware of that may impact your ability to participate during trip activities?

What is your T-shirt size?

x-small small medium large x-large

Emergency Contact Information

Name

Phone

Second phone number

Waiver:

I, (or the undersigned parent/guardian of the participant named above if under 18 years of age), authorize the calling of a doctor and the providing of necessary medical services in the event of injury or illness. I authorize one or more of the following persons to make emergency medical care decisions on my (or on behalf of the participant under 18), if required by law or a health care provider: Trip leader Anna Hadorn or another adult designated by her. I authorize these persons to act in my place to consent to all necessary and appropriate x-ray examinations, anesthetic, medical or surgical diagnosis or treatment, and hospital care. I understand that the staff and volunteers of WPC will not be responsible for medical expenses incurred on the basis of this authorization. I further agree to notify the NextGen Director (Anna) in writing of any health changes that would restrict participation in any mission trip activities. I also understand that the NextGen Director and volunteer youth leaders reserve the right to restrict participation from any activity that they do not feel is within the physical capabilities participants.

I understand that photo/video may be taken on the trip and accept that that this media may be posted to WPC's website or social media platforms.

Payment:

Payments can also be made by cash or check and brought to the office.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

This trip is taking place Sunday, July 14 - Saturday, July 20. The total cost of the trip is $500 per person. Please reach out to Anna Hadorn with any questions. There are three required meetings to prepare for the trip, happening the at 6:30 pm on the first Sunday of May (5/5), June (6/2), and July (7/7). Please sign up by Wednesday, April 10th!

Mission Trip 2024 - Boston

Description

Please Fix the Following